Airplane Data Record_Electronic.xls

XLS spreadsheet 114 KB Posted

Attached to
FFP Initial Attack Helicopter-Eastern PA
Solicitation number
6100054072
Issued by
Carbon County, Jenkintown Borough, Pennsylvania

About this file

This document is a Forest Service Airplane Data Record form that is used to document inspection and operational details for aircraft used under a state and local government contract or rental agreement. The form covers information about the operator, aircraft make/model, serial number, gross weight, passenger capacity, and authorized uses of the aircraft such as passenger transport, cargo, resource reconnaissance, fire reconnaissance, and air attack. It also captures details on the airframe, engines, propellers, and avionics equipment, as well as operating certificates and required equipment. The form must be completed and approved by the contracting agency prior to use of the aircraft under the contract.

The document provides guidance on filling out the form, including references to applicable regulations and standards. It specifies that the form may be completed electronically or manually, and provides instructions on protecting and unprotecting the worksheet. Contact information is included for questions, comments, and suggestions related to the form.

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FS-5700-21, Part 1 Form

FS-5700-21, Part 1 (Rev. 03/2008)
OMB 0596-0015 (Exp. date omitted by approval of OMB)
USDA - Forest Service1. Contract/Rental Agreement No.
AIRPLANE DATA RECORD2. Item No.
3. Designated Base
(Reference FSH 5709.16)4. Region/Area
SECTION I - Operator & Aircraft Information (Fill in Blanks)
1. Operator2. Address (Street, City, State & ZIP Code)
3. Phone No.4. Make and Model5. FAA Registration No.6. Manufacturer's Serial No.
7. Gross Weight8. No. of Passenger Seats9. Hobbs/Tach Reading10. Hobbs/Tach Reading at Last 100 Hour Insp.
FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA
11. Authorized Uses (Initial appropriate boxes)Expires (Fill in the Blank)December-00
(Line Through Unapproved Uses)
a.Passengerf.Backcountry Airstrip
b.Cargog.Approved MEL (D95) (MMEL Rev No.)
c.Resource Reconnaissanceh.Equipped w/Autopilot (Single Pilot IFR) (A15)
d.Fire Reconnaissancei.Other
e.Air Attack(Type)j.Other
12. Approved By (Signature)13. Title14. Region15. Date
SECTION II - Airframe Information (Fill in the Blanks)SECTION III - Engine, Prop & Governors (Fill in the Blanks)
1.Aircraft Total Time1.Engine Make & Model
2.Last Complete Inspection Date C/W2.TBO:HoursCalendarYears
AnnualManufacturerAAIP(D73)(D101)HSI
(Time/Date Since New, O/H & HSI)
3.Last 100 Hr/Phase (Total Time)3.HoursLeftRight
4.Last 100 Hr/Phase (Date)HSILeftRight
5.Weight & Balance (36 Months Multi; 5 Yr Single)DateLeftRight
Date of Last Weighing1/3/190512/31/9912/31/99
Empty WeightEquipment List4.Propeller(Time/Date Since New or O/H)
6.Flight Manual Rev No.DateTBO:HoursCalendarYears
7.AirworthinessRegistrationHoursLeftRight
8.Airframe Logbooks (91.417)DateLeftRight
12/31/9912/31/99
9.Engine Logbooks5. Prop Governor(Time/Date Since New or O/H)
10Propeller LogbooksTBO:HoursCalendarYears
11.FAA Form 337HoursLeftRight
12.AD's & ListingDateLeftRight
13.Time Change List (As required)SECTION IV - Operating Certificates (Fill in the Blanks)
14.Service Bulletins (As Required)1.14 CFR 135 Certificate No.
15.Aging Aircraft (D485)(As Required)2.14 CFR 137 Certificate No.
12/31/9912/31/99
SECTION V - Equipment (X appropriate boxes)
SatisfactorySatisfactory
YesNoYesNo
1.Hobbs Installation5.Flight Instruments
2.Free Air Temperature Gauge6.Engine Instruments
3.Seat Belt (All)7.Skis/Wheels
4.Shoulder Harness (Front)8.Floats(Size:)
FS-5700-21 (1/08)
N Number0Make & Model0Inspection Date31-Dec-99
SECTION V (Continued) - Equipment (X appropriate boxes)
SatisfactorySatisfactory
YesNoYesNo
9.First Aid Kit20.High Visibility Markings
10.Survival Kit21.HAZMAT Handbook(w/Current Exemption Letter)
11.Fire Extinguisher22.Procurement Document in Aircraft
12.Light - Navigation/Landing23.Ops Specs/Ops Manual in aircraft
13.Stobes and/or Beacon (Anti-Collision)24.Security Devices
14.De-ice/Anti-ice Equipment1
15.Cabin Heater2
16.Pulselites3Incorporated into Preflight checklist
17.Navigation Charts/Approach Plates25.Additional Items
18.Shooting Door/Window26.
19.Shoulder Harness w/Inertia Reel (Rear)27.
SECTION VI - Avionics (X appropriate boxes or Annotate N/A for items Not Required)
SatisfactorySatisfactory
PassFailPassFail
1. ELT - Battery Due Date()----------
2. ELT 91.207 Complied With27. Audio Controls (No.)
3. ELT TSO#91a12628. Transmitter Selectors
4. #1 VHF-AM Comm. Transceiver72076029. Receiver Selectors
5. #2 VHF-AM Comm. Transceiver72076030. Microphone/Drop Cords
6. #1 VHF-FM Comm. Transceiver(Type)31. Trasnceiver PTT
7. #2 VHF-FM Comm. Transceiver(Type)32. ICS Hot Mic/VOX
8. #3 VHF-FM Comm. Transceiver(Type)33. ICS PTT
9. Aux FM Provisions34. Check Pilot ICS
10. GPS or LORAN (Panel Mounted / Handheld)PanelHand35. Rear Seat PTT
(Mark IFR / VFR as applicable)IFRVFR36. ICS 2,3,4 orInph Positions
11. GPS Database (Expiration Date)-------------------------------------
12. Transponder (Per 91.413) (Due Date)37. Avionics Placarding
13. Altimeter/Static (Per 91.411)(Due Date)38. General Condition
14. #1 VOR/LOC (IFR 30 Day Due)39. Avionics Records
15. #2 VOR/LOC (IFR 30 Day Due)40. Accessory Power (3 Pin)
16. Glideslope41. Supplementary Radio Kit Capability
17. Marker Beacon42. FM Antenna (For Backcountry Airstrips)
18. DME or TACAN43. Other
19. ADF or IFR GPS Substitute44. Other
20. Magnetic Compass Placard45. Other
21. Cockpit Voice Recorder46. Other
22. Flight Data Recorder----------
23. TAWS/GPWS'----------------------------------
24. TCAS/TCAD47. Avionics Inspection Completed By:----------
25. Autopilot w/Flight Director----------
26.Automated Flight Following System----------
AFF Website Check----------
Notes/Discrepancies:
SECTION VII - (Forest Service Inspector Use Ony)
Card Issue Date:Fed Resources Database UpdatedCopy filed with Contract and/or CO

11f. Approved MEL:

Verify against the Ops Specs D095.

11e. Equipped w/Autopilot (Single Pilot IFR):

Verify against Ops Specs A015 11d. Air Attack:

Per the Contract and the National Avionics standards. Enter type "I, II, III, or IV" Current standards can be found at: http://www.fs.fed.us/fire/niicd/avionics/index.html 11c. Resource Reconnaissance:

Verify it meets the minimum requirements of the National Avionics Standards. Current standards can be found at: http://www.fs.fed.us/fire/niicd/avionics/index.html

11. Authorized Uses:

Initial as required per the Contract. Line through items not Authorized for, on the Card placed in the Aircraft.

1. Hobbs Installation:

Required for most Contracts.

4. Shoulder Harnesses: Although not necessarily required by the FAR's, This is Required for All Aircraft. Shoulder harnesses are not required to have a TSO number, but must be inspected and the inertia reels operationally checked.

12. Approved By:

Print and Sign on card issued to Operator.

3. Seat Belts: Must be marked either TSO C22 Safety Belts, C114 Torso Restraint Systems, or have a Military Desigantion Number.

26. Automated Flight Following System:

As required by Contract.

2. ELT 91.207 Complied With:

Verify Annual Inspection complied with per FAR 91.207d (1-4).

9. Aux FM Provision::

Verify 10-pin connector operation and VHF-FM antenna installed.

10. GPS or LORAN:

Identify whether Portable or Panel Mounted.

Air Attack Type I & II must be panel mounted.

Identify whether VFR or IFR Approved.

11. GPS Database:

Enter Expiration of Database.

Under no circumstances may it be more than 1 year old.

40. Accessory Power (3 Pin):

Verify correct power and polarity.

41. Supplementary Radio Kit Capability:

(Air Attack Kit) Antenna(s) and space for kit.

21. Cockpit Voice Recorder:

As required by Contract. Verify Battery Due Date, Beacon (ping) Check, etc., current.

22. Flight Data Recorder:

As required by Contract. Verify Battery Due Date, Beacon (ping) Check, etc., current.

23. TAWS/GPWS:

As required by Contract.

For Turbine Powered Aircraft Class A Class B Part 121 All N/A Part 135 10 or more Pax seats 6-9 Pax seats

24. TCAS/TCAD:

As required by Contract.

ELT TSO #: Either TSO 91a, or after January 31, 2009, TSO 126a Security Devices:

Must have two independent electrical and/or mechanical devices. Must be incorporated into preflight checklists. Locked doors or windows are not acceptable.

1. Contract/Rental Agreement No:

Enter Contract or Rental Agreement Number.

2. Item No:

Some Contracts have multiple awards. If so enter the Item Number from Section B for this award.

3. Designated Base:

Designated Base as listed Section B of the Contract. If a CWN type Contract, enter the Operators Home Base.

4. Region/Area:

Enter the Region which awarded the Contract. Not the Issuers region.

1. Operator:

Enter the Company's Name, not the name listed on the aircraft's Registration Certificate.

2. Address:

Enter the Address as listed on the Contract.

3. Phone No:

Don't forget the Area Code.

4. Make and Model:

Self Explanatory, i.e. Cessna 206F.

5. FAA Registration No:

Self Explanatory. However, if Foreign Registered enter the appropriate Registration Number, i.e. C-FYKH.

7. Gross Weight:

Gross Weight as listed in the Aircraft Flight Manual. Ensure you check for any STC's and Flight Manual Supplements that might increase (or decrease) the Gross Weight.

8. No. of Passenger Seats:

Total number of seats, excluding the pilot(s) seat(s).

10. Hobss/Tach at Last 100 Hr. Inspection:

Or Annual Inspection. You may want to enter both if aircraft has both. i.e. 268.3/2857.9.

Backcountry Airstrip:

Must have an AFF System installed, and an FM Antenna or AUX FM capability.

Type Inspection:

1. Enter "X" if under an Annual Inspection Program.

2. Leave "Blank" if under a Manufacturer's Program.

3. Enter "-" (DASH) if under a AAIP

7. Fire Extinguisher:

Verify charge, security of mounting and Annual/Hydro (6 year) dates.

6. Survival Kit:

Usually required for All Special Mission Aircraft. Minimum requirements can be found in Section J of the Contract.

5. First Aid Kit:

Required for All Aircraft. Minimum requirements can be found in Section J of the Contract.

11c. Fire Reconnaissance:

Verify it meets the minimum requirements of the National Avionics Standards. Current standards can be found at: http://www.fs.fed.us/fire/niicd/avionics/index.html

FS-2700-21, Part 2 (FIRE CARD)

FS-2700-21, Part 2 (Rev. 03/2008)
OMB 0596-0015 (Exp. date omitted by approval of OMB)
USDA - Forest Service1. Contract/Rental Agreement No.0
INTERAGENCY FIRE2. Item No.0
3. Designated Base0
AIRPLANE DATA RECORD
4. Region/Area0
(Reference FSH 5709.16)
SECTION I - Operator & Aircraft Information (Fill in Blanks)
1. Operator2. Address (Street, City, State & ZIP Code)
00
3. Phone No.4. Make and Model5. FAA Registration No.6. Manufacturer's Serial No.
0000
7. Gross Weight8. No. of Passenger Seats9. Hobbs/Tach Reading10. Hobbs/Tach Reading at Last 100 Hour Insp.
0000
FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA
11. Authorized Uses (Initial appropriate boxes)Expires (Fill in the Blank)December-00
(Line Through Unapproved Uses)
a.0Passengerf.0Backcountry Airstrip
b.0Cargog.0Approved MEL (D95) (MMEL Rev No.0)
c.0Resource Reconnaissanceh.0Equipped w/Autopilot (Single Pilot IFR)(A15)
d.0Fire Reconnaissancei.0Other
e.0Air Attack(Type)j.0Other
12. Approved By (Signature)13. Title14. Region15. Date
0

3. Phone No:

Don't forget the Area Code.

7. Gross Weight:

Gross Weight as listed in the Aircraft Flight Manual. Ensure you check for any STC's and Flight Manual Supplements that might increase (or decrease) the Gross Weight.

FS-2700-21, Part 3

FS-2700-21, Part 3 (Rev. 03/2008)
OMB 0596-0015 (Exp. date omitted by approval of OMB)
USDA - Forest Service1. Contract/Rental Agreement No.0
AIRPLANE DATA RECORD2. Item No.0
3. Designated Base0
4. Region/Area0
(Reference FSH 5709.16)
SECTION I - Operator & Aircraft Information (Fill in Blanks)
1. Operator2. Address (Street, City, State & ZIP Code)
3. Phone No.4. Make and Model5. FAA Registration No.6. Manufacturer's Serial No.
0000
7. Gross Weight8. No. of Passenger Seats9. Hobbs/Tach Reading10. Hobbs/Tach Reading at Last 100 Hour Insp.
0000
FOR EMPTY WEIGHT SEE CURRENT WEIGHT AND BALANCE DATA
11. Authorized Uses (Initial appropriate boxes)Expires (Fill in the Blank)December-00
(Line Through Unapproved Uses)
a.0Passengerf.0Backcountry Airstrip
b.0Cargog.0Approved MEL (D95) (MMEL Rev No.0)
c.0Resource Reconnaissanceh.0Equipped w/Autopilot (Single Pilot IFR)(A15)
d.0Fire Reconnaissancei.0Other
e.0Air Attack(Type)j.0Other
12. Approved By (Signature)13. Title14. Region15. Date
0

5. FAA Registration No:

Self Explanatory. However, if Foreign Registered enter the appropriate Registration Number, i.e. C-FYKH.

Instructions

INSTRUCTIONS FOR FS 5700-21 AIRPLANE DATA RECORD
1. A. This form may be filled in on the computer, or blank forms may be printed and filled in by hand.

Computer: When the information is entered on FS-5700-21, Part 1, the information will be automatically transferred to the FS-5700-21, Parts 2 and 3.

B. Printing: Click on the tab along the lower edge of the worksheet to gain access to the individual sheets FS-5700-21, Part 1; FS-5700-21, Part 2; FS-5700-21, Part 3.

The forms should print one page for each form. If this does not happen do the following:

(1) Click on “File”, “Page Setup”, Margins”, Check that all margins are set to: “.5”.

2. SPECIAL USES – If a Special Use is Authorized, clicking on the item on the “5700-21 Front Page”, a check mark will appear in the provided space. You will have to Initial the Authorized Uses on the card, and line through the items not authorized. Any Additional Uses will also automatically be filled in on the 5700-21 Card.
A RED TRIANGLE indicates a drop down box which provides information on what information is required, or what should be looked for, as in the example in the upper right corner of this block.

3. To Insert your information in blocks 13. Title, and 14. Region, Click on “Tools”, “Protection”, “Unprotect Sheet”. Remember to Re-Protect the sheet and Card(s) afterward.

SUGGESTION: Before or After completing a form, save it to a separate file i.e. N12345.xls. I recommend you make a folder for “Airplanes” and then sub-folders for the individual operators, and save the different “N” numbers in the operators file.

Please forward all comments, questions, noted discrepancies, and suggestions to:

Gil Elmy Work: 801-622-9170 Cell: 801-540-8473 e-mail: gelmy@fs.fed.us

BURDEN AND NONDISCRIMINATION STATEMENTS
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0015. The time required to complete this information collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay voice). USDA is an equal opportunity provider and employer.

Instructions for Notes:

A Box like this will appear if you place the cursor over a RED TRIANGLE on the forms, which will provide pertinent information regarding the information petaining to an item on the forms.

File details come from the government source that posted it. Updated .